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18.11.2008 Health

Prof Akosah warns:NHIS FACES COLLAPSE… If source of funding is not broadened

By Issah Alhassan, Kumasi - Ghanaian Chronicle
Prof Akosah warns:NHIS FACES COLLAPSE… If source of funding is not broadened

THE FORMER Director General of the Ghana Health Services and defeated presidential aspirant of the Convention People's Party (CPP), Prof. Agyemang Badu Akosah, has cast doubt over the continuous sustainability of the country's National Health Insurance Scheme, if the government does not broaden the financial security and source of funding for the scheme.

According to him, the nation's much-touted healthcare system, which replaced the cash and carry under the National Democratic Congress (NDC) regime, may not be sustainable in the near future, if plans are not put in place to make sure other sources of funding are obtained to operate the scheme.

Prof. Akosah, who made the statement in an interview with The Chronicle in Kumasi, noted that the current system of the operation of the scheme brings undue pressure on the 2.5 per cent levy, which according to him, was not adequate enough for the sustainability of the scheme.

He said even though the National Health Insurance Scheme claims to have registered over 11 million subscribers, representing over 60 per cent of the total population, the percentage of people directly contributing to the premium was very negligible, adding that there are no available statistics to indicate the number of people who paid premium last year and enjoyed health service, as against those who did not pay, but did enjoy the scheme.

Prof. Akosah said while the authority further claims to have invested about GH¢270 million through the 2.5per cent levy, they have failed to tell Ghanaians the amount of money they have acquired since the levy was introduced, and the expenditure involved in the process of running the scheme.

The former Director General of Ghana Health Services noted that as a first step towards improving the running of the scheme, the management of the funds must be separated from the regulations and the rules governing the operation of the scheme, so that the work of the National Health Insurance Authority would be solely with the regulations of the district mutual, private mutual and health insurances, to make sure they function properly.

He stated that there was the need to separate the two functions, so that the monies from the NHIS Levies would be in the hands of the fund managers, which would be independent of the authority and a Board of Trustees set up to manage the contributions that the fund managers would bring to the authority, so that the duty of the authority would be solely to make the sure the district mutual schemes were performing effectively.

“If we fail to separate the two, then the question is, is the authority the fund managers, or they have contracted an agent to do that on their behalf; are they getting the best investment? the answer is no.”

Prof. Akosah further observed “even in the health sector when we are talking about repayment scheme, we advertised, all the banks applied, and ECOBANK won through fair and competitive bidding, so I do not see why the same thing cannot be done with the NHIS, whereby a private entity would be contracted to manage the funds.”

He further proposed that the subscription to the scheme, must be made compulsory to each and every Ghanaian, so that there would be a lot of people paying the premium, so that the cost can become low, adding “if car insurance policy is compulsory, then I do not see why the same cannot be applied to health.”

He said by so doing, the period payment of premiums could be extended to two years, because by then a lot more people would have been hooked onto the scheme and the amount of premium could be increased by the rate of inflation.

The defeated CPP presidential hopeful also suggested the alteration of the system of payment of the premium, to make it more culturally friendly, so that factors and payment of the premium would be very flexible and accessible to all.

He emphasised that by making the payment of premiums flexible and culturally friendly, people who do not have physical cash to pay their contributions, could barter their products, say cattle or ram, as a form of premium, or be made to enjoy the scheme in the “off seasons,” so that they can pay later when their products are harvested.

He observed that indigenes in the northern part of the country particularly, may not have the physical cash to pay as premium, but if a barter system of payment was put in place, they can be made to exchange their cattle or ram as a substitute for payment.

He further proposed the setting up of health and sports lottery, as a form of sourcing additional funding to support the operations of the scheme.

On the NDC-proposed one premium system of health insurance scheme, whereby a beneficiary only pays one premium in his or her lifetime, Prof.Akosah said such a policy would never be feasible, because according to him, the provision of quality healthcare was so expensive that no government can afford to offer lifetime health insurance policy.